Health

A case of Rh isoimmunization: should threatened first-trimester abortion be an indication for Rh immune globulin prophylaxis?

Article Abstract:

Rh factor incompatibilities occur when the blood of a mother that does not contain the factor (Rh negative) mixes with blood of the fetus that does contain the factor (Rh positive) to cause the production of destructive antibodies. Although the incompatibility does not affect the current pregnancy, subsequent pregnancies are at risk for fetal red blood cell destruction. Potential blood mixing can occur during a threatened spontaneous abortion. Although one half of the patients who have bleeding in the first three months of pregnancy miscarry, the remainder maintain the pregnancy. It is not clear whether all women who have first trimester bleeding should undergo Rh immune globulin prophylaxis, an injection to prevent antibody reactions from occurring in subsequent pregnancies. It is recommended that all Rh-negative women have the immune globulin injection by the 28th week of pregnancy. A case is presented of a 35-year-old woman who was RH negative and had had a previous child with an Rh-negative father. She had four abortions and received Rh immune globulin after each procedure. No antibodies were detected before the first abortion or the first delivery. She came to the hospital complaining of cramping and bleeding. A pelvic ultrasound revealed a viable 8.5-week-old fetus. The father of this child was Rh positive. She was not given Rh immune globulin and was told to visit with an obstetrician. The patient's antibody screen was negative at the prenatal visit. Amniocentesis was performed at another institution at 15 weeks of pregnancy and 300 micrograms of Rh immune globulin were given. When the patient transferred to another facility, antibody testing was positive, which was thought to be caused by passive antibodies; Rh immune globulin was given. However, analysis of the fetus' blood at delivery was strongly positive. The mother's blood was analyzed and found to have an extremely high antibody concentration. This is the first reported case of a missed maternal sensitization developing after bleeding in the first three months of pregnancy. Although an obstetrician would probably have given the immune globulin, emergency personnel did not. It is recommended that Rh immune globulin should be given to all Rh-negative women who experience first-trimester bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reconstructive procedures for the gynecologic surgeon

Article Abstract:

Certain procedures should be used in minor reconstructive surgery of the genitals. The goal of this type of surgery is to improve both the appearance and the function of the genitals. Patients may require reconstructive surgery of the genitals for a wide variety of reasons. These include repairing birth defects, injuries and abnormalities caused by an infection or childbirth. The procedures that a gynecologic surgeon should know include Z-plasty, full-thickness skin grafting, skin flaps, W-plasty and transposition skin flaps. Surgeons in other subspecialties use these types of procedures, and they can all be adapted for minor reconstructive surgery of the genitals. The need for these procedures in gynecologic surgery may be infrequent, but they may be useful in certain situations. A gynecologic surgeon needs a thorough understanding of tissue dynamics to avoid an adverse surgical outcome.

The functional anatomy of the urethra: role of the pubourethral ligaments

Article Abstract:

The pubourethral ligaments and muscular attachments appear to play a role in holding the urethra in proper position. This information has suggested a surgical technique that may improve the success of surgery for urinary incontinence. Researchers dissected cadavers to confirm the exact anatomy of these ligaments. They also compared urethral stability in 30 women with stress incontinence and 30 problem-free women. All 30 women with stress incontinence displayed urethral instability when holding their breath and bearing down versus none of the problem-free women.